Corrective Osteotomy and Fusion in an Adolescent Male with Painful Type V Coccyx Deformity: A Case Report

Abstract Coccydynia is a painful condition arising from the lowermost part of the vertebra with a prevalence of around 2.7%. Coccygectomy has emerged as an effective surgical method. Type V (retroverted and posteriorly angulated apex) is a rare variant (5%). Coccygeal osteotomy to correct the Type V deformity and alleviate pain has not been described previously in the literature. This study aims to report a unique case of Type V coccyx deformity with severe coccydynia. He underwent osteotomy, correction of Type V deformity, and fusion with a good outcome. A 15-year-old boy presented with severe pain in the tailbone region for 6 months. Clinical examination revealed puckering of skin at the tip of the protruding coccyx. The surgical technique is described. Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores were recorded preoperatively and at the final follow-up. He had a preoperative VAS score of 6 and an ODI score of 24. X-ray imaging revealed a retroverted coccyx (with posterior angulation) and a magnetic resonance imaging scan suggested an elongated coccyx with outward concavity (posterior angulation). The retroverted coccyx was corrected by osteotomy and a small triangular piece of bone graft was placed at the sacrococcygeal disc space after removing the disc. Two 3.5 mm cortical screws on either side were used to transfix the coccyx to the distal sacrum. Clinical and radiological improvements were observed every 6 months. At a follow-up of 3 years, he remains pain-free with a VAS score of 0. His ODI score was 0. This unique case of corrective osteotomy and fusion of the Type V coccygeal deformity to a normal angulation resulted in a pain-free life in an adolescent. This type of corrective osteotomy and fusion has not been described before.